Quantitative imaging to evaluate malignant potential of IPMNs

Oncotarget. 2016 Dec 27;7(52):85776-85784. doi: 10.18632/oncotarget.11769.


Objective: To investigate using quantitative imaging to assess the malignant potential of intraductal papillary mucinous neoplasms (IPMNs) in the pancreas.

Background: Pancreatic cysts are identified in over 2% of the population and a subset of these, including intraductal papillary mucinous neoplasms (IPMNs), represent pre-malignant lesions. Unfortunately, clinicians cannot accurately predict which of these lesions are likely to progress to pancreatic ductal adenocarcinoma (PDAC).

Methods: We investigated 360 imaging features within the domains of intensity, texture and shape using pancreatic protocol CT images in 53 patients diagnosed with IPMN (34 "high-grade" [HG] and 19 "low-grade" [LG]) who subsequently underwent surgical resection. We evaluated the performance of these features as well as the Fukuoka criteria for pancreatic cyst resection.

Results: In our cohort, the Fukuoka criteria had a false positive rate of 36%. We identified 14 imaging biomarkers within Gray-Level Co-Occurrence Matrix (GLCM) that predicted histopathological grade within cyst contours. The most predictive marker differentiated LG and HG lesions with an area under the curve (AUC) of .82 at a sensitivity of 85% and specificity of 68%. Using a cross-validated design, the best logistic regression yielded an AUC of 0.96 (σ = .05) at a sensitivity of 97% and specificity of 88%. Based on the principal component analysis, HG IPMNs demonstrated a pattern of separation from LG IPMNs.

Conclusions: HG IPMNs appear to have distinct imaging properties. Further validation of these findings may address a major clinical need in this population by identifying those most likely to benefit from surgical resection.

Keywords: IPMN; fukuoka; pancreatic cyst; quantitative imaging; radiomics.

MeSH terms

  • Adenocarcinoma, Mucinous / diagnostic imaging
  • Adenocarcinoma, Mucinous / pathology*
  • Aged
  • Aged, 80 and over
  • Carcinoma, Pancreatic Ductal / diagnostic imaging
  • Carcinoma, Pancreatic Ductal / pathology*
  • Carcinoma, Papillary / diagnostic imaging
  • Carcinoma, Papillary / pathology*
  • Female
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Pancreatic Neoplasms / diagnostic imaging
  • Pancreatic Neoplasms / pathology*
  • Retrospective Studies
  • Tomography, X-Ray Computed